APITHERAPY: A stinging endorsement

* Sufferers of chronic pain are believers in use of bee venom, but U.S. doctors remain skeptical

A bee sting is one of summer's unpleasant moments. First there's the sudden jab of a stinger. Then comes burning, redness, swelling and itching.

Although most of us cringe at the thought of even a single sting, thousands of people seeking relief from maladies such as rheumatoid arthritis or multiple sclerosis court the wrath of honeybees through an unproven treatment called apitherapy.

Clutched in the fingertips or a pair of tweezers, an angry bee pumps poison into an already inflamed, stiff or weakened limb or other body part. The insects may sting a willing human dozens of times daily, several days a week, possibly for years.

Not surprisingly, most mainstream physicians voice stinging criticism of bee-venom therapy, which for an unlucky few can trigger a violent allergic reaction leading within minutes to dizziness, swollen air passages, unconsciousness and even death.

One-year study to begin

A clinical trial, however, using injections of bee venom extract to determine its safety, has the scientific community abuzz.

Scheduled to begin this year, the one-year study at Georgetown University in Washington, D.C., is the first federally sanctioned study of apitherapy for treating multiple sclerosis, a chronic, progressive, often crippling neurological disorder.

"Probably 99.8 percent of American doctors don't know a thing about it because most don't read the literature or inquire about why it does work," says Jean-Francois Lariviere, spokesman for the Hillsboro, Ohio-based American Apitherapy Society, which promotes a variety of health products from the hive.

The society knows of at least 10,000 people worldwide who either go to sting therapists or treat themselves.

Figueroa treats himself with bee venom for a touch of arthritis in his left arm, as well as minor workaday aches and pains.

On this occasion, a bee on a kamikaze mission dangles from its stinger, which is embedded in his elbow.

"A lot of people ... they say I'm crazy to do this kind of thing. But I don't think so," Figueroa says, laughing. "The bees. They make me feel real good."

No one understands exactly why bee venom is helpful in diseases such as rheumatoid arthritis, in which the immune system turns against the body, damaging muscles, joints, cartilage and other tissues. But it's thought to contain substances that reduce pain and swelling, increase circulation and stimulate the immune system to suppress the underlying disease process.

Tantalizing success stories abound about apitherapy. Many who've had it insist the discomfort is tolerable and rave about how much better they feel - often for the first time since they've been ill.

Some chronic-pain sufferers treat themselves with bee stings or seek the services of beekeepers like Figueroa. Others, emboldened by tales of miracle cures, seek doctors willing to inject them with purified bee venom extract.

An equally unpleasant treatment, injections at least avoid handling live, angry bees or killing the insects, which die soon after losing their stingers.

Critics: Medicine safer

Safety-conscious apitherapists, particularly the few physicians who use it, test patients for an allergy to bee venom before attempting a treatment.

From 1 percent to 5 percent of the population is allergic to bee venom, says Rick Vetter, an entomology researcher at the University of California, Riverside, and an authority on the toxin.

About 40 Americans a year die from severe allergic reactions to stings from bees, wasps, yellow jackets and hornets, according to the American College of Allergy, Asthma & Immunology, based in Arlington Heights, Ill.

"People attempting apitherapy should have quick access to an emergency room or have epinephrine kits nearby. Mistakes can be fatal," Vetter says.

Critics point out that although there is no cure for chronic conditions such as rheumatoid arthritis or multiple sclerosis, medicine has safer, better-tested ways to control symptoms or slow their progression.

Lack of solid data

Indeed, their biggest objection is a dearth of solid data showing how or why apitherapy works - or that it even works at all. Nor does the federal Food and Drug Administration endorse it beyond its approval of the Georgetown University study. However, those researchers say they might examine bee venom's effectiveness in future controlled clinical trials.

"Bee-venom therapy seems to cause the immune system to develop a response to the venom and to help arthritis," says rheumatologist J. Michael Finley, an assistant professor at Loma Linda University School of Medicine. "But it's not scientifically proven."

Finley, who is on the Arthritis Foundation's Advisory Board, says that about 30 percent of chronic-pain patients typically report feeling better after nearly any sort of change in conventional therapy. Meditation or prayer also can be beneficial. The same effect could be true of bee venom therapy, he suggests.

"I don't doubt it helps some people," says Vetter, the UCR entomologist. "It's probably more than a placebo effect and is worth studying even if it only helps a few."

Dr. Christopher M. Kim, one of the nation's foremost medical practitioners of apitherapy, acknowledges there are few controlled studies to guide doctors who might want to offer it to patients with longstanding arthritis.

Even so, Kim, who is medical director of the Monmouth Pain Institute in Red Bank, N.J., conducted a study 12 years ago that concluded injecting bee venom was safe, effective and free of serious side effects in people with longstanding rheumatoid or osteoarthritis who were not allergic to it.

For two years he gave 108 patients who had failed to respond to conventional treatments bee venom injections twice a week.

He gradually increased the number of shots in each subsequent session until patients markedly improved or got completely better.

Most subjects showed slight improvement after the third treatment and marked benefits after an average of 12 sessions. He observed no complications or serious side effects in any of the subjects.

Dr. Al Robert Franco, a Riverside rheumatologist and researcher who treats arthritis with another controversial therapy - antibiotics - thinks bee venom is safe for patients not allergic to it.

"But it may not be very effective," says Franco, who does not offer the therapy. "And while you're getting an ineffective treatment, your disease may advance. But that's true of many things we prescribe."

Treatment widely used elsewhere

Using live bee stings to treat arthritis and other ills originated thousands of years ago. References to this treatment can be found in ancient Egyptian and Greek medical writings. Over the centuries, bee venom has been a folk medicine remedy for many conditions, ranging from asthma to varicose veins.

Still widely used in China, Eastern Europe, Asia and South America, apitherapy remains controversial in the United States.

Charles Mraz, a Vermont beekeeper, began using it in 1934 to cure his own arthritis caused by rheumatic fever. Mraz, now 93, has been treating people free for the asking for the past seven decades. Over the years, his anecdotal accounts have encouraged many others to try or offer it.

Naysayers or the lack of hard evidence don't dissuade Figueroa.

Back at his apiary, he brushes the doomed bee off his arm, then scrapes out the stinger with a fingernail. As hundreds of bees buzz harmlessly around him, he reaches into a swarm-filled hive, plucks another insect by its wings and presses it against his arm.

Figueroa may start with one, two or three bee stings, adding one a day for 10 days. Then he'll gradually taper back to zero.

"The next day I really feel better, but sometimes it works immediately," he says.

Figueroa learned the technique in Mexico from his father who also kept hives. Today, Figueroa performs apitherapy on his nephews for aches or minor injuries.

His wife, Valarie, was twice stung by accident on a surgery scar on her lower back two years ago while helping him handle a swarm of bees. Valarie recalls that the stings generated instant heat that relieved numbness and pain radiating into her right leg. She claims to be nearly pain-free.

Thousands of multiple sclerosis patients likewise have reported significant relief after repeated bee stings, often as many as 30 per session and an average of 3,000 per year, according to researchers at Georgetown University Medical Center. But researchers acknowledge there was no way to gauge how much venom anyone received.

Their one-year clinical trial, conducted under a $250,000 grant from the Multiple Sclerosis Association of America, will divide 16 patients into four groups. Each group will receive varying concentrations of bee venom extract in 10 twice-weekly injections.

— 12/31/1969

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